Judicare Referral Certificate

Client listed below on the Judicare Referral Certificate is authorized by Maryland Volunteer Lawyers Service to receive up to 20 hours of legal services at the rate of $80 per hour (not to exceed $1,600) from a Judicare panel attorney. The attorney must complete the Attorney Agreement and return it to MVLS after the initial client interview. The attorney must also complete the Billing and Case Closure section and submit it to MVLS under the terms set forth by MVLS to receive payment for services.

Attorney and Case Information

DATE*

ATTORNEY NAME*

FirstLast

EMAIL ADDRESS*

ATTORNEY FIRM NAME

ATTORNEY ADDRESS

Street AddressAddress Line 2CityStateZIP Code

CLIENT NAME*

FirstLast

CLIENT ADDRESS

Street AddressAddress Line 2CityStateZIP Code

CLIENT PHONE NUMBER

ADVERSE PARTY

OPPOSING COUNSEL

MVLS CASE NUMBER

DATE OF REFFERAL

NATURE OF LEGAL PROBLEM (please select one)

30- Adoption

32- Divorce/Separation/Annulment

34- Name Change

38-Support (i.e., alimony, child support)

39- Other Family Issues (please specify)

31- Custody/Visitation

33- Adult Guardianship

37- Domestic Abuse

44- Child Guardianship

If 39-Other Family issues - please specify

ANTICIPATED CLOSURE DATE

I have interviewed the above-mentioned client and will provide representation.